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Am J Emerg Med. 2018 Dec;36(12):2225-2231. doi: 10.1016/j.ajem.2018.04.007. Epub 2018 Apr 7.

No association between metoclopramide treatment in ED and reduced risk of post-concussion headache.

Author information

1
Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada. Electronic address: nbresee@cheo.on.ca.
2
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. Electronic address: magliplay@cheo.on.ca.
3
Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: sasha.dubrovsky@mcgill.ca.
4
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. Electronic address: aledoux@cheo.on.ca.
5
University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: fmomoli@uottawa.ca.
6
Department of Pediatrics, Hospital Ste. Justine, University of Montreal, Montreal, Quebec, Canada.
7
Department of Pediatrics, Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. Electronic address: Stephen.Freedman@albertahealthservices.ca.
8
Department of Pediatrics and Clinical Neurosciences, Alberta's Children's Hospital, Calgary, Alberta, Canada. Electronic address: kbarlow@ucalgary.ca.
9
Department of Pediatrics, University of Alberta, Women and Children's Health Research Institute, Edmonton, Alberta, Canada. Electronic address: lricher@ualberta.ca.
10
University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. Electronic address: nbarrowman@cheo.on.ca.
11
Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. Electronic address: rzemek@cheo.on.ca.

Abstract

OBJECTIVE:

There is a lack of definitive pediatric literature on effective pharmacotherapy for persistent post-concussion headache symptoms. This study assessed whether acute metoclopramide treatment in the Emergency Department (ED) was associated with a reduction in persistent headache in children at 1- and 4-weeks post-concussion.

METHODS:

Children aged 8-17years with acute concussion presenting to 9-Canadian Pediatric EDs were enrolled in a prospective cohort study, from August 2013-June 2015. Primary and secondary outcomes were persistent headache at 1- and 4-week post-injury respectively. Headache persistence was based on the one and four-week headache scores minus recalled pre-injury score using the Post-Concussion Symptom Inventory. The association between metoclopramide and headache persistence at 1- and 4-weeks were examined using unadjusted and adjusted regression and 1:4 propensity score matching model.

RESULTS:

Baseline assessments were completed in 2095 participants; 65 (3.1%) received metoclopramide within 48-hours of injury. At 1- and 4-weeks, 54% (963/1808) and 26% (456/1780) of participants had persistent headache relative to baseline respectively. In unadjusted analysis, no association between metoclopramide and headache persistence at 1-week was found [treated vs. untreated: 1-week (53% vs. 53%; relative risk (RR)=1.0 (95%CI: 0.8, 1.3); 4-weeks (27.3% vs. 25.6%; RR=1.0 (95% CI: 0.9, 1.2)]. Metoclopramide was not associated with lower headache risk on propensity score matching [treated vs. untreated: 1-week, n=220 (52% vs. 59.4%; RR=0.8 (95%CI: 0.6, 1.2) and 4-weeks, n=225 (27.1% vs. 32.8%; RR=0.9 (95%CI: 0.8, 1.1)].

CONCLUSION:

Metoclopramide administration was not associated with a reduction in headache persistence in children seeking ED care due to a concussion. Further research is necessary to determine which pharmacotherapies may be effective for acute and persistent post-concussive headache.

KEYWORDS:

Concussion; Headache; Metoclopramide; Pediatric; Pharmacotherapy; Post-concussion symptoms

PMID:
29661668
DOI:
10.1016/j.ajem.2018.04.007
[Indexed for MEDLINE]

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